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* 1. Are you a patient or GP practice employee?

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* 2. Which GP practice are you registered with/employed by?

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* 3. How would you rate your experience of the POD?

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* 4. What do you think could be done to improve your experience of the POD?

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* 5. What do you think are the positives to the POD?

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* 6. What changes would you like to see the CCG make to the POD?

If you would like to discuss your feedback regarding the POD with the CCG, please provide your details below. Please note, that we will not share these details with any third parties.

In order to keep your personal information confidential and if you are completing this survey offline as a physical paper version, please return your survey in a securely sealed envelope to the following address: Communications Team, NHS West Lancashire CCG, Hilldale, Wigan Road, Ormskirk, Lancashire, L39 2JW.

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* 7. Name:

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* 8. Telephone number:

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* 9. Email address:

NHS West Lancashire CCG collates equality and diversity information to understand who we are engaging with from our local community. 

All data collected is anonymised and used exclusively for the monitoring and improvement of health outcomes for the local population and for compliance with our public sector equality duty.

For further information about Equality and Diversity and our public sector equality duty under the Equality Act 2010, please visit the following website: https://www.gov.uk/government/organisations/department-of-health-and-social-care/about/equality-and-diversity

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* 10. What is your age?

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* 11. How would you describe your gender?

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* 12. Is your current gender identity the same as the sex you were registered with at birth?

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* 13. Do you consider yourself to be...

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* 14. Are you a carer?

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* 15. If you answered yes to the previous question, how many hours of care do you provide?

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* 16. Do you consider yourself to have a disability?

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* 17. If you answered yes to the previous question, what is your level of disability?

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* 18. What is your ethnicity? Please select all that apply.

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